Indocyanine Green (ICG) lymphography is a novel imaging technique that visualises an individual’s superficial lymphatic flow in real-time in the clinic setting. It observes lymphatic changes causing lymphoedema following cancer-related treatments, providing an individualised ‘road map’ of a person’s functional lymphatics. Cancer-related lymphoedema management is currently prescribed based on assumed lymphatic drainage pathways. ICG lymphography has shown adaptations do not routinely follow these assumed pathways, thus universally applied lymphoedema treatments have mixed effectiveness. Currently, this technique is only available in one private setting in Australia.
This study aimed to explore the process, barriers and enablers to successful implementation of an ICG lymphography imaging clinic within a public cancer-related lymphoedema service.
A 12-month implementation process was conducted. Eligible patients not responding to their existing lymphoedema management were offered the procedure. The implementation process involved knowledge building, infrastructure development, pilot implementation and evaluation. Service data was recorded. The Consolidated Framework for Implementation Research (CFIR) underpinned implementation and evaluation to explore barriers and enablers to success.
Implementation commenced May 2019 with 2-3 patients with upper or lower limb cancer-related lymphoedema seen per fortnightly clinic. A total of 18 clinics were held with 31 patients seen. 64% had upper limb lymphoedema. Appointments averaged 93.1 minutes with average scan time of 54.9 and 62.8 minutes for upper and lower limb respectively. Medical consultant and occupational therapist performed the procedure. No adverse events were recorded. Consumable cost was $158/procedure. All participants required adaptation to therapy following ICG lymphography.
Successful implementation of an ICG lymphography clinic in a public setting was achieved. However, factors including staff training and retention, cost and time intensity are potential barriers to sustainability despite the staff and patient reported benefits of ICG lymphography in cancer-related lymphoedema management.